Opioid Update 2018
CenCal Health Pharmacy Update
2018 Opioid Morphine Equivalent Dose (MED) Limit
CenCal Health and its Pharmacy Benefits Manager (MedImpact), are working together to communicate formulary changes to plan providers. With the approval of CenCal Health's Pharmacy & Therapeutics Committee and in coordination with MedImpact, CenCal Health has begun a Multiphase Implementation Plan to deter over-utilization of opioids, and update utilization management measures.
Effective 7/1/2018, CenCal Health will be implementing the following MED (Morphine Equivalent Dose) edits to help minimize the over utilization of opioids:
- MED (Morphine Equivalent Dose) >120mg
Soft-Edit at the pharmacy, can be overriden by the pharmacy
- MED (Morphine Equivalent Dose) >200mg
Hard-Stop at the Pharmacy, Prior Authorization would need to be submitted to justify the MED>200mg
In an effort to minimize disruption to members on Chronic Opioid Therapy, we are notifying providers of the MED limits that will be effective 7/1/2018. For providers with members over the future MED limit, please see the recommended actions below to ensure that there is no disruption in therapy.
Actions to Take:
- Assess patient and review diagnosis, treatment plan, and possible titration from medications and or willingness to obtain addiction treatment from the County Drug and Alcohol Services Program.
- Santa Barbara County: 1-888-868-1649
- San Luis Obispo County: 1-800-838-1381
2. If member's medical condition necessitates continuation of therapy above the 200mg MED, the following information must be submitted to obtain Prior Authorization, starting 7/1/2018:
- Diagnosis with medical justification
- Pain Assessment
- Urine Screening-Shows concordance with prescriptions
- Attempts made to titrate therapy
- Alternative treatment/therapies attempted
Please contact CenCal Health Pharmacy Services Department at (805) 562-1080 if you have any questions.
Diabetes Formulary Update
SGLT-2 Inhibitor Preferred Agents
Effective 8/1/2018, with the approval of CenCal Health's Pharmacy and Therapeutics Committee, Steglatro and Jardiance will be CenCal Health's preferred SGLT-2 Inhibitors. Segluromet and Synjardy/Synjardy XR will also become the preferred SGLT-2 Inhibitor/Metformin combination products.
| Brand Name |
Generic Name |
Strength |
Formulary Status |
| Steglatro |
Ertugliflozin |
5mg and 15mg tablets |
Formulary, QL #30/30ds |
| Jardiance |
Empagliflozin |
10mg and 25mg tablets |
Formulary, QL #30/30ds |
| Segluromet |
Ertugliflozin/Metformin |
2.5-500mg, 2.5-1000mg, 7.5-500mg
and 7.5mg-1000mg tablets |
Formulary, QL #60/30ds |
| Synjardy |
Empagliflozin/Metformin |
5-500mg, 12.5-500mg, 5-1000mg
and 12.5-1000mg tablets |
Formulary, QL #60/30ds |
| Synjardy XR |
Empagliflozin/Metformin |
5-1000mg, 10-1000mg, 12.5-1000mg
and 25-1000mg tablets |
Formulary, QL # 60/30ds |
In efforts to minimize disruption to CenCal Health providers and members, all current utilization of non-formulary agents will be grandfathered.
For more information on these changes, please contact CenCal Health's Pharmacy Department at (805) 562-1080.
Formulary Updates
DUR: Educational Articles